Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery

Recent trials have proven the benefits of endovascular treatment for patients with stroke from emergent large vessel occlusions (ELVOs).1–5 Optimal management of these patients involves attention to pre-procedural, intra-procedural, and post-procedural elements. However, many of the ideal treatment approaches following endovascular stroke therapy remain controversial. This document synthesizes current recommendations from the best available evidence to provide guidance in the post-procedural management of a patient undergoing stroke thrombectomy. This document was constructed by the Standards and Guidelines Committee of the Society for NeuroInterventional Surgery, a multidisciplinary committee composed of practitioners with backgrounds including neuroradiology, vascular neurosurgery, stroke neurology, and neurocritical care. We reviewed electronic databases for publications related to the management of acute stroke patients post-procedure, using both broad and narrow search terms. We subsequently evaluated those results for papers with randomized clinical results, which were given the highest priority. The remaining papers were assessed on the basis of individual methodology, and recommendations were made based on the data available. In the absence of supporting adequate clinical trial evidence, the committee made consensus recommendations. Each recommendation is graded, where possible, with a level of evidence utilizing the American Heart Association/American Stroke Association grading system.6 This document represents one of a continuum related to acute stroke intervention, including other documents on prehospital management, training standards for thrombectomy, and management of ELVO patients.7–9 ### Post-thrombectomy care environment ELVO patients require careful monitoring in a stroke unit or intensive care unit. Stroke units provide dedicated, specialized, multidisciplinary inpatient care for ELVO patients. Patients treated in this environment are more likely to survive, regain independence, and return home than those receiving less organized service.10 Stroke units are characterized by protocol guided care, adherence to guidelines, and coordination of care provided by various services.11–14 Furthermore, a dedicated stroke unit is preferable to a mobile consultative …